HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (12)DATE (MM/DDiYYYY)
ACORE) CERTIFICATE OF LIABILITY INSURANCE
4/3/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: RM LongmOnl
TrueNorth Companies, L.C. PHONE -
275 S. Main St Suite 100 303-776-5122 (FAX,rNo:303-776.5495
Longmont CO 80501 —ADDRESS: long montsm truenorthcom anies.com
INSURED
Simpson Electric, Inc
P. O. Box 2196
Loveland CO 80539
SIMPELE•01
INSURERS AFFORDING COVERAGE '` v NAIL #
INSURER A: Owners Insurance Company 32700
INSURER B : Auto -Owners Insurance Company
18988
INSURERC: Pinnacol Assurance
41190
INSURER D :
INSURER E :
r1nv1=0AP_1ZC (11=13TIPICATF NI IURFR• 1'Y2)F,SRR59 REVISION NUMBER:
T THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND_ CONDITIONS OF SUCH POLICIES. LIMITS_ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NSR r TYPE OF INSURANCE POLICY NUMBER _ �&� CY E F POLICY FXP
LTR LIMBS
A
X COMMERCIAL GENERAL LIABILITY
Y j
74144089
4/1/2019
4/1/2020
EACH OCCURRENCE
$1,000,000
—• I--
CLAIMS -MADE OCCUR
` �7iTaAGE'12511ENT€.D.__.-._...-
PR MI$E$_aP@_?9o;Erence
----
$300,000
MED EXP (Arly.onepersonL
PERSONAL & ADV INJURY
$10,000
$1,000,000
`
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
—
$ 2,000,000
X POLICY i` JP T LOC
$
OTHER:
A
AUTOMOBILE LIABILITY
4268555900 4/1/2019
4/1/2020
COMBINED SINGLE LIMIT
$1,000,000
__.� .._......_. _.__ -.
BODILY INJURY (Per person)
$—
X.. ANY AUTO
I
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED AUTOS ONLY X AUOT09 0NLDV
BODILY INJURY (Per accident)
_$ —
-
d9nJ MACE
;_(Per _-__..__ _
--
$
_$_
8
X UMBRELLALIAB X OCCUR
4268565901 4/1/2019
4/1/2020 EACH OCCURRENCE
$1,000,D00
EXCEE1SSSUUAB CLAIMS -MADE
DED 1 X 1 RETENTION $ --non--
I
AGGREGATE
$1,000,000
C WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
4182129 4/1/2019
4/1/2020
X PTAT EST
E.L. EACH ACCIDENT
$1.000,000
E.L. DISEAS_E.- EA EMPLOYEE
—
$1,000,000_
OFFICERIMEMBEREXCLUDED?
(Mandatory In NH)
NIA
E.L. DISEASE - POLICY LIMIT
_
$ 1,000,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
tt
I
I
i
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If mote space is required)
FICATE HOLDER
City of Fort Collins
Attn: Laurie
P.O. Box 580
Fort Collins CO 80522
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
U 1988-2015 ACORD CUHPUHA I IUN. All rlgntS reserve0.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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